S T A T E   O F   N E W   Y O R K
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                                  7439

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                              May 12, 2015
                               ___________

Introduced by M. of A. CAHILL -- read once and referred to the Committee
  on Insurance

AN  ACT  to amend the insurance law, in relation to rating of individual
  and small group health insurance policies

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Subparagraph  (A)  of  paragraph  1 of subdivision (e) of
section 3231 of the insurance law, as amended by chapter 107 of the laws
of 2010 and as further amended by section 104 of part A of chapter 62 of
the laws of 2011, is amended to read as follows:
  (A) An insurer desiring to increase or decrease premiums for any poli-
cy form subject to this section shall submit a rate filing  or  applica-
tion to the superintendent.
  An  insurer shall send written notice of the proposed rate adjustment,
[including the specific change requested,] to  each  policy  holder  and
certificate  holder affected by the adjustment on or before the date the
rate filing or application  is  submitted  to  the  superintendent.  The
notice  shall prominently include mailing and website addresses for both
the department of financial services and the  insurer  through  which  a
person may, within thirty days from the date the rate filing or applica-
tion  is  submitted  to  the  superintendent,  contact the department of
financial services or insurer to receive additional  information  or  to
submit  written  comments to the department of financial services on the
rate filing or application. The superintendent shall establish a process
to post on the department's website, in a timely  manner,  all  relevant
written  comments  received  pertaining to rate filings or applications.
The insurer shall provide a copy of the  notice  to  the  superintendent
with the rate filing or application. The superintendent shall immediate-
ly  cause  the  notice  to  be  posted  on  the  department of financial
services' website. The superintendent shall determine whether the filing
or application shall become effective as filed, shall  become  effective

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10031-01-5
              

A. 7439                             2

as  modified,  or shall be disapproved. The superintendent may modify or
disapprove the rate filing or application if  the  superintendent  finds
that  the  premiums are unreasonable, excessive, inadequate, or unfairly
discriminatory,  and may consider the financial condition of the insurer
when approving, modifying or disapproving any premium adjustment.  [The]
PROVIDED,  HOWEVER,  ANY ADJUSTMENT TO A RATE FILING OR APPLICATION MUST
BE IN ACCORDANCE WITH GENERALLY ACCEPTED ACTUARIAL PRINCIPLES AND  PRAC-
TICES,  AND  MUST  BE  APPROPRIATE  FOR THE POPULATION TO BE COVERED AND
SERVICES TO BE FURNISHED UNDER THE POLICY. AN INITIAL determination [of]
REGARDING THE RATE FILING OR APPLICATION SHALL BE  MADE  BY  the  super-
intendent  [shall  be supported by sound actuarial assumptions and meth-
ods, and shall be rendered in writing between] NO LATER THAN thirty [and
sixty] days from the date the rate filing or application is submitted to
the superintendent. THE SUPERINTENDENT'S INITIAL DETERMINATION SHALL  BE
PROVIDED  TO AN INSURER IN WRITING WITHIN THE THIRTY DAY TIME PERIOD AND
SHALL DESCRIBE IN DETAIL THE ACTUARIAL ASSUMPTIONS AND METHODS  USED  IN
THE  SUPERINTENDENT'S  DETERMINATION.  Should the superintendent require
additional information from the insurer in order to make [a] AN  INITIAL
determination,  the  superintendent shall require the insurer to furnish
such information, and in such event, the [sixty] THIRTY  days  shall  be
tolled  and shall resume as of the date the insurer furnishes the infor-
mation to the superintendent. [If the superintendent requests additional
information less than ten days from the expiration  of  the  sixty  days
(exclusive  of  tolling),  the  superintendent  may extend the sixty day
period an additional twenty days to make a determination. The] FOLLOWING
THE ISSUANCE OF THE INITIAL DETERMINATION, AN INSURER SHALL HAVE FIFTEEN
DAYS TO APPEAL THE DETERMINATION IN WRITING. IF AN INITIAL RATE DETERMI-
NATION IS APPEALED, THE SUPERINTENDENT SHALL HAVE FIFTEEN DAYS TO  ISSUE
A REVISED DETERMINATION. IF THE INITIAL DETERMINATION IS NOT APPEALED BY
AN  INSURER,  IT SHALL BECOME FINAL FIFTEEN DAYS AFTER IT IS ISSUED. ALL
FINAL RATE DETERMINATIONS SHALL BE CERTIFIED BY AN ACTUARY DESIGNATED BY
THE SUPERINTENDENT WHO MEETS THE QUALIFICATION STANDARDS ESTABLISHED  BY
THE  AMERICAN  ACADEMY  OF  ACTUARIES  AND FOLLOW THE PRACTICE STANDARDS
ESTABLISHED BY THE ACTUARIAL STANDARDS BOARD. NOTWITHSTANDING THE  FORE-
GOING,  THE  application  or  rate  filing  will be deemed approved if a
determination is not  rendered  within  the  time  allotted  under  this
section.  An  insurer  shall  not  implement  a  rate adjustment THAT IS
APPROVED BY THE SUPERINTENDENT unless  the  insurer  provides  at  least
[sixty]  THIRTY  days  advance  [written]  notice  of  the [premium rate
adjustment approved by the superintendent] ADJUSTMENT, EITHER THROUGH  A
POSTING  ON  ITS  WEBSITE OR BY WRITTEN NOTICE to each policy holder and
certificate holder affected by the rate adjustment.
  S 2. Paragraph 2 of subdivision (c) of section 4308 of  the  insurance
law,  as  amended  by  chapter  107  of  the laws of 2010 and as further
amended by section 104 of part A of chapter 62 of the laws of  2011,  is
amended to read as follows:
  (2)  A  corporation  desiring to increase or decrease premiums for any
contract subject to this subsection shall submit a rate filing or appli-
cation to the superintendent. A corporation shall send written notice of
the proposed rate adjustment, [including the specific change requested,]
to each contract holder and subscriber affected by the adjustment on  or
before  the  date  the  rate  filing  or application is submitted to the
superintendent. The notice shall prominently include mailing and website
addresses for both the department of financial services and  the  corpo-
ration  through which a person may, within thirty days from the date the
rate filing or application is submitted to the  superintendent,  contact

A. 7439                             3

the  department  of  financial  services or corporation to receive addi-
tional information or to submit written comments to  the  department  of
financial services on the rate filing or application. The superintendent
shall  establish  a  process  to  post on the department's website, in a
timely manner, all relevant written comments received pertaining to rate
filings or applications. The corporation shall provide  a  copy  of  the
notice  to  the  superintendent with the rate filing or application. The
superintendent shall immediately cause the notice to be  posted  on  the
department  of  financial  services'  website.  The superintendent shall
determine whether the filing or application shall  become  effective  as
filed,  shall become effective as modified, or shall be disapproved. The
superintendent may modify or disapprove the rate filing  or  application
if  the  superintendent finds that the premiums are unreasonable, exces-
sive, inadequate, or  unfairly  discriminatory,  and  may  consider  the
financial condition of the corporation in approving, modifying or disap-
proving any premium adjustment[. The]; PROVIDED, HOWEVER, ANY ADJUSTMENT
TO  A  RATE  FILING  OR APPLICATION MUST BE IN ACCORDANCE WITH GENERALLY
ACCEPTED ACTUARIAL PRINCIPLES AND PRACTICES, AND MUST BE APPROPRIATE FOR
THE POPULATION TO BE COVERED AND SERVICES  TO  BE  FURNISHED  UNDER  THE
CONTRACT.  AN INITIAL determination [of] REGARDING THE RATE OF FILING OR
APPLICATION SHALL BE MADE BY the superintendent [shall be  supported  by
sound  actuarial assumptions and methods, and shall be rendered in writ-
ing between] NO LATER THAN thirty [and sixty] days  from  the  date  the
rate  filing  or  application  is  submitted  to the superintendent. THE
SUPERINTENDENT'S INITIAL DETERMINATION SHALL BE  PROVIDED  TO  A  CORPO-
RATION  IN  WRITING WITHIN THE THIRTY DAY TIME PERIOD AND SHALL DESCRIBE
IN DETAIL THE ACTUARIAL ASSUMPTIONS AND METHODS USED IN THE  SUPERINTEN-
DENT'S  DETERMINATION.  Should  the  superintendent  require  additional
information from the corporation in order to make [a] AN INITIAL  deter-
mination,  the  superintendent  shall require the corporation to furnish
such information, and in such event, the [sixty] THIRTY  days  shall  be
tolled  and  shall  resume  as of the date the corporation furnishes the
information to the superintendent. [If the superintendent requests addi-
tional information less than ten days from the expiration of  the  sixty
days (exclusive of tolling), the superintendent may extend the sixty day
period an additional twenty days, to make a determination.  The] FOLLOW-
ING  THE ISSUANCE OF THE INITIAL DETERMINATION, A CORPORATION SHALL HAVE
FIFTEEN DAYS TO APPEAL THE DETERMINATION IN WRITING. IF AN INITIAL  RATE
DETERMINATION IS APPEALED, THE SUPERINTENDENT SHALL HAVE FIFTEEN DAYS TO
ISSUE  A  REVISED  DETERMINATION.    IF THE INITIAL DETERMINATION IS NOT
APPEALED BY A CORPORATION, IT SHALL BECOME FINAL FIFTEEN DAYS  AFTER  IT
IS  ISSUED. ALL FINAL RATE DETERMINATIONS SHALL BE CERTIFIED BY AN ACTU-
ARY DESIGNATED BY THE SUPERINTENDENT WHO MEETS THE QUALIFICATION  STAND-
ARDS  ESTABLISHED  BY  THE  AMERICAN ACADEMY OF ACTUARIES AND FOLLOW THE
PRACTICE  STANDARDS  ESTABLISHED  BY  THE  ACTUARIAL  STANDARDS   BOARD.
NOTWITHSTANDING  THE  FOREGOING,  THE application or rate filing will be
deemed approved if a determination  is  not  rendered  within  the  time
allotted  under  this  section. A corporation shall not implement a rate
adjustment THAT IS APPROVED BY THE SUPERINTENDENT unless the corporation
provides at least [sixty] THIRTY days advance [written]  notice  of  the
[premium  rate  adjustment  approved  by the superintendent] ADJUSTMENT,
EITHER THROUGH A POSTING ON ITS WEBSITE OR BY  WRITTEN  NOTICE  to  each
contract holder and subscriber affected by the rate adjustment.
  S 3. This act shall take effect immediately.